U.S. patent application number 14/203376 was filed with the patent office on 2014-09-18 for heart sound simulator.
This patent application is currently assigned to CERCACAR LABORATORIES, INC.. The applicant listed for this patent is CERCACOR LABORATORIES, INC.. Invention is credited to Cristiano Dalvi, Marcelo M. Lamego.
Application Number | 20140276115 14/203376 |
Document ID | / |
Family ID | 51530505 |
Filed Date | 2014-09-18 |
United States Patent
Application |
20140276115 |
Kind Code |
A1 |
Dalvi; Cristiano ; et
al. |
September 18, 2014 |
HEART SOUND SIMULATOR
Abstract
The disclosure includes systems and methods directed toward
simulating heart sounds. The system can include an optical sensor
configured to obtain data for generating a plurality of
plethysmograph waveforms at a first frequency. The heart sound
simulator can also include a processor in communication with the
sensor. The processor can be configured to generate a heart sound
signal based on at least one of the plurality of plethysmograph
waveforms.
Inventors: |
Dalvi; Cristiano; (Lake
Forest, CA) ; Lamego; Marcelo M.; (Cupertino,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
CERCACOR LABORATORIES, INC. |
IRVINE |
CA |
US |
|
|
Assignee: |
CERCACAR LABORATORIES, INC.
IRVINE
CA
|
Family ID: |
51530505 |
Appl. No.: |
14/203376 |
Filed: |
March 10, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61782374 |
Mar 14, 2013 |
|
|
|
Current U.S.
Class: |
600/479 |
Current CPC
Class: |
A61B 5/04028 20130101;
A61B 5/7278 20130101; A61B 5/024 20130101; A61B 5/02416 20130101;
A61B 5/14551 20130101; A61B 5/7221 20130101; A61B 5/7415
20130101 |
Class at
Publication: |
600/479 |
International
Class: |
A61B 5/00 20060101
A61B005/00; A61B 5/024 20060101 A61B005/024 |
Claims
1. A heart sound simulator configured to determine heart sounds
from photo-plethysmograph data, the heart sound simulator
comprising: an optical sensor configured to output one or more
sensor signals responsive to attenuation of light by body tissue,
said optical sensor including a light source and light detector;
and a processor receiving at least one signal responsive to said
sensor signal, said processor configured to process the received
signal to determine a plurality of plethysmograph waveforms and
output a heart sound signal responsive to at least one of said
plurality of plethysmograph waveforms.
2. The heart sound simulator of claim 1, wherein the processor is
further configured to use calibration information to determine the
heart sound signal.
3. The heart sound simulator of claim 1, wherein the processor is
further configured to oversample said at least one plethysmograph
waveform.
4. The heart sound simulator of claim 3, wherein said
plethysmograph waveforms include a first frequency and wherein said
processor is further configured to oversample said at least one
plethysmograph waveform at a second frequency higher than the first
frequency.
5. The heart sound simulator of claim 4, wherein the second
frequency is at least about 100 times the first frequency.
6. The heart sound simulator of claim 1, further comprising a noise
generator configured to generate pseudo-random noise.
7. The heart sound simulator of claim 6, further comprising a
filter configured to filter the pseudo-random noise for one or more
natural heart tones.
8. The heart sound simulator of claim 1, wherein said processor is
configured to output the heart sound signal in an audio format.
9. The heart sound simulator of claim 1, wherein said processor
receives said at least one signal or said plurality of
plethysmograph waveforms from a memory storing trends of said at
least one signal or said plurality of plethysmograph waveforms.
10. The heart sound simulator of claim 9, wherein said processor
receives said at least one signal or said plurality of
plethysmograph waveforms corresponding to a caregiver-selected time
window from said trends.
11. The heart sound simulator of claim 10, wherein said processor
receives said at least one signal or said plurality of
plethysmograph waveforms corresponding to a time window around one
or more abnormal values in measurement data.
12. The heart sound simulator of claim 11, wherein said abnormal
values were determined proximate a time when said processor
received said at least one signal from said sensor.
13. A method of simulating heart sounds using one or more
plethysmograph signals responsive to light attenuated by body
tissue detected by an optical sensor in proximity to a measurement
site, the method comprising: receiving signals responsive to light
attenuated by body tissue; identifying a plurality of
plethysmograph waveforms using a signal processor; selecting at
least one plethysmograph waveform using said signal processor; and
electronically generating a heart sound signal based on the at
least one plethysmograph waveform.
14. The method of claim 13, wherein said generating the heart sound
signal comprises generating an audio signal that simulates heart
sounds.
15. The method of claim 13, wherein identifying the plurality of
plethysmograph waveforms comprises sampling a plurality of signal
streams at a first frequency.
16. The method of claim 15, further comprising oversampling the at
least one plethysmograph waveform at a second frequency higher than
the first frequency.
17. The method of claim 16, wherein the second frequency is at
least about 100 times the first frequency.
18. The method of claim 13, further comprising generating
pseudo-random noise.
19. The method of claim 18, further comprising filtering the
pseudo-random noise for one or more natural heart tones.
20. The method of claim 13, wherein generating the heart sound
signal comprises transforming the at least one plethysmograph
waveform using a heart sound model.
21. The method of claim 13, further comprising outputting the heart
sound signal in an audio format.
22. A method of producing clinically relevant information from
trend data, said information being different from said stored trend
data, the method including: acquiring said trend data, wherein said
trend data includes one or more of an input signal, plethysmograph,
or measurement data, and wherein the input signal is responsive to
light attenuated by body tissue; selecting a time window in said
trend data; and producing data different from said trend data, said
produced data having a higher frequency than the stored data.
23. The method of claim 22, wherein the clinically relevant
information includes heart sounds.
24. The method of claim 22, wherein the clinically relevant
information includes an EKG output.
25. The method of claim 22, wherein selecting the time window in
said trend data is carried out by a caregiver.
26. The method of claim 25, wherein the time window corresponds to
one or more abnormalities in said trend data.
27. The method of claim 26, wherein the abnormalities are in said
measurement data.
28. The method of claim 22, wherein selecting the time window in
said trend data is automatic based on one or more abnormalities in
said trend data.
29. The method of claim 22, wherein the clinically relevant
information includes heart sounds and an EKG output.
30. The method of claim 29, wherein the heart sounds and the EKG
output are synchronized.
31. The method of claim 22, wherein the clinically relevant
information is synchronized with the plethysmograph.
Description
PRIORITY CLAIM AND REFERENCE TO RELATED APPLICATIONS
[0001] The present application claims priority benefit under 35
U.S.C. .sctn.119(e) to U.S. Provisional Patent Application Ser. No.
61/782,374, filed Mar. 14, 2013, titled Heart Sound Simulator;
hereby incorporated in its entirety by reference herein.
BACKGROUND
[0002] 1. Field
[0003] The disclosure relates to systems and methods for simulating
heart sounds.
[0004] 2. Description of the Related Art
[0005] Clinicians commonly use stethoscopes to listen to sounds
inside the body. For example, stethoscopes can be used to listen to
lung sounds and heart sounds. Some stethoscopes can be used with a
recording device to record the internal body sounds. However, these
audio recordings can require large amounts of data storage.
[0006] Newer technologies provide for electronic patient monitoring
using acoustic sensors. For example, Masimo Corporation of Irvine,
Calif. commercially provides noninvasive and continuous monitoring
of breathing, specifically the respiration rate using an adhesive
sensor with an integrated acoustic transducer that is applied to
the patient's neck. In some instruments, data from the acoustic
sensor is used to drive an audio transducer such that the
instrument reproduces audio the same as or very similar to the
original sensed breathing. The data may be audibly presented
substantially real time or stored for later playback. However, as
with electronic stethoscopes, the recording of this data can
require large amounts of data storage.
SUMMARY
[0007] For purposes of summarizing the disclosure, certain aspects,
advantages and novel features of the inventions have been described
herein. It is to be understood that not necessarily all such
advantages can be achieved in accordance with any particular
embodiment of the inventions disclosed herein. Thus, the inventions
disclosed herein can be embodied or carried out in a manner that
achieves or optimizes one advantage or group of advantages as
taught herein without necessarily achieving other advantages as can
be taught or suggested herein.
[0008] One aspect of this disclosure is directed toward a heart
sound simulator configured to determine heart sounds from
photo-plethysmograph data. The heart sound simulator can include an
optical sensor in communication with a processor. For example, the
sensor can include a light source and a light detector and can be
configured to output one or more sensor signals responsive to
attenuation of light by body tissue. The processor can receive the
at least one signal responsive to the sensor signal and can be
configured to process the received signal to determine a plurality
of plethysmograph waveforms and output a heart sound signal
responsive to at least one of the plurality of plethysmograph
waveforms. In some embodiments, the sensor may advantageously be a
noninvasive sensor including one or more light sources and one or
more light detectors positioned proximate patient tissue at a
measurement site by a sensor housing or positioning member such as
adhesive tape. The detector(s) may advantageously detect light
attenuated by pulsing blood. In some embodiments, the sensor may
include active pulsing technologies designed to move tissue near a
measurement site in a predetermined manner at a predetermined
frequency. In an embodiment, the sensor comprises an oximetry
sensor.
[0009] In the above mentioned aspect, the processor can be further
configured to use calibration information to determine the heart
sound signal.
[0010] In any of the above mentioned aspects, the processor can be
further configured to oversample the at least one plethysmograph
waveform. The plethysmograph waveforms can include a first
frequency and the processor can be configured to oversample the at
least one plethysmograph waveform at a second frequency greater
than the first frequency. In some embodiments, the second frequency
is substantially greater, and, in certain embodiments, the second
frequency is at least about 100 times the first frequency.
[0011] In any of the above mentioned aspects, the heart sound
simulator can include a noise generator configured to generate
pseudo-random noise. The heart sound simulator can also include a
filter configured to filter the pseudo-random noise for one or more
heart tones.
[0012] In any of the above mentioned aspects, the processor can be
further configured to output the heart sound signal in an audio
format.
[0013] In any of the above mentioned aspects, the processor can
receive the at least one signal or the plurality of plethysmograph
waveforms from a memory storing trends of the at least one signal
or the plurality of plethysmograph waveforms. The at least one
signal or the plurality of plethysmograph waveforms can correspond
to a caregiver-selected time window from said trends. The time
window can surround one or more abnormal values in measurement
data. The abnormal values can be determined proximate a time when
said processor received said at least one signal from said
sensor.
[0014] Another aspect of this disclosure is directed toward a
method of simulating heart sounds using one or more plethysmograph
signals responsive to light attenuated by body tissue detected by
an optical sensor in proximity to a measurement site. The method
can include receiving signals responsive to light attenuated by
body tissue. The method can include electronically identifying a
plurality of plethysmograph waveforms using a signal processor,
electronically selecting at least one plethysmograph waveform using
the signal processor, and electronically generating a heart sound
signal based on the at least one plethysmograph waveform. The
method may also include creating audible heart sounds through a
transducer responsive to the heart sound signal.
[0015] In the above mentioned method aspect, identifying the
plurality of plethysmograph waveforms can include electronically
sampling a plurality of signal streams at a first frequency. The
method can also include electronically oversampling the at least
one plethysmograph waveform at a second frequency higher than the
first frequency.
[0016] In any of the above mentioned method aspects, the method can
include electronically generating pseudo-random noise. The method
can also include electronically filtering the pseudo-random noise
for one or more natural heart tones.
[0017] In any of the above mentioned method aspects, the method can
also include electronically transforming the at least one
plethysmograph waveform using a heart sound model.
[0018] In any of the above mentioned method aspects, the method can
also include electronically outputting the heart sound signal in an
audio format.
[0019] Yet another aspect of this disclosure is directed toward a
non-transitory computer storage having stored thereon a system
configured to execute in one or more processors. The system can
include a calibration module configured to select at least one
plethysmograph waveform. The system can also include a
plethysmograph processing module configured to generate a heart
sound signal based on the at least one plethysmograph waveform.
[0020] In the above mentioned non-transitory computer storage
aspect, the calibration module can be configured to select the at
least one plethysmograph waveform using calibration information
based at least in part on parameters associated with creating an
audio output and/or physiological data.
[0021] In any of the above mentioned non-transitory computer
storage aspects, the plethysmograph processing module can be
configured to transform the at least one plethysmograph waveform
using a heart sound model.
[0022] Yet another aspect of this disclosure is directed toward a
method of producing clinically relevant information different from
stored trend data. The method can include acquiring the trend data,
which can include one or more of an input signal, plethysmograph,
or measurement data. The input signal can be, for example,
responsive to light attenuated by body tissue. The method can also
include selecting a time window in the trend data and producing
data different from the trend data. In certain aspects, the
produced data can have a higher frequency than the stored data.
[0023] In the above mentioned method of producing clinically
relevant information, the clinically relevant information can
include heart sounds and/or an EKG output, which can be
synchronized with each other and/or to a plethysmograph.
[0024] In any of the above mentioned methods of producing
clinically relevant information, selecting the time window can be
automatic or carried out by a caregiver based on one or more
abnormalities in the trend data, including, but not limited to,
abnormalities in the measurement data.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] Various embodiments will be described hereinafter with
reference to the accompanying drawings. These embodiments are
illustrated and described by example only, and are not intended to
limit the scope of the disclosure. In the drawings, similar
elements have similar reference numerals.
[0026] FIG. 1 is a graph illustrating a standard plethysmograph
waveform.
[0027] FIG. 2 is a graph illustrating the absorption contribution
of various blood and tissue components.
[0028] FIG. 3 is a graph illustrating an intensity "plethysmograph"
pulse oximetry waveform.
[0029] FIG. 4 is a block diagram of an exemplary data flow through
one or more signal processors to simulate a heart sound using a
plethysmograph waveform.
[0030] FIG. 4a is another block diagram of an exemplary data flow
through one or more signal processors to simulate a heart sound
using a plethysmograph waveform.
[0031] FIG. 5 is a block diagram of another exemplary data flow
through one or more signal processors to simulate a heart sound
using a plethysmograph waveform.
[0032] FIG. 5a is another block diagram of another exemplary data
flow through one or more signal processors to simulate a heart
sound using a plethysmograph waveform.
[0033] FIG. 6 is a block diagram of an exemplary data flow through
one or more signal processors to transform a plethysmograph
waveform to an EKG waveform.
[0034] FIG. 6a is another block diagram of an exemplary data flow
through one or more signal processors to transform a plethysmograph
waveform to an EKG waveform.
DETAILED DESCRIPTION
[0035] Pulse oximeter systems are commonly used to noninvasively
measure physiological data. In general, a pulse oximeter system
includes one or more optical sensors communicating with a
processing instrument to display the noninvasively measured values.
The sensor includes a light source that irradiates tissue of a
patient and one or more photodetectors that detect the radiation
after attenuation thereof by the tissue. The sensor communicates
the detected signal(s) to the processing instrument, or patient
monitor, where the instrument often removes noise from and
otherwise preprocesses the received signal(s). The instrument then
processes the signal(s) to determine measurement values for one or
more monitored parameters or combinations thereof. The patient
monitor may numerically or graphically display various measurement
values of physiological parameters, combinations of measurement
values, or graphical representations of the same. In some
embodiments, the graphical representation may include
analog-appearing representations. In other embodiment, the
graphical representation may include, but is not limited to, the
patient's plethysmograph, which is a visual display of the
patient's pulse contour and pulse rate. The instrument may display
a myriad of other calculated measurements of other physiological
parameters.
[0036] FIG. 1 illustrates the standard plethysmograph waveform 100,
which can be electronically derived using a pulse oximeter. The
waveform 100 is a display of blood volume, shown along the y-axis
110, over time, shown along the x-axis 120. The shape of the
plethysmograph waveform 100 is a function of heart stroke volume,
pressure gradient, arterial elasticity, and peripheral resistance.
The ideal waveform 100 displays a broad peripheral flow curve, with
a short, steep inflow phase 130 followed by a 3 to 4 times longer
outflow phase 140. The inflow phase 130 is the result of tissue
distention by the rapid blood volume inflow during ventricular
systole. During the outflow phase 140, blood flow continues into
the vascular bed during diastole. The end diastolic baseline 150
indicates the minimum basal tissue perfusion. During the outflow
phase 140 is a dicrotic notch 160, the nature of which is disputed.
Classically, the dicrotic notch 160 is attributed to closure of the
aortic valve at the end of ventricular systole. However, it may
also be the result of reflection from the periphery of an initial,
fast propagating, pressure pulse that occurs upon the opening of
the aortic valve and that precedes the arterial flow wave. A double
dicrotic notch can sometimes be observed, although its explanation
is obscure, possibly the result of reflections reaching the sensor
at different times.
[0037] FIG. 2 is a graph 200 illustrating a compartmental model of
the absorption of light at a tissue site illuminated by a pulse
oximetry sensor. The graph 200 has a y-axis 210 representing the
total amount of light absorbed by the tissue site, with time shown
along an x-axis 220. The total absorption is represented by layers,
including the static absorption layers due to tissue 230, venous
blood 240, and a baseline of arterial blood 250. Also shown is a
variable absorption layer due to the pulse-added volume of arterial
blood 260. The profile 270 of the pulse-added arterial blood 260 is
seen as the plethysmograph waveform 100 depicted in FIG. 1.
[0038] FIG. 3 illustrates the photo-plethysmograph intensity signal
300 detected by a pulse oximeter sensor. A pulse oximeter does not
directly detect the standard plethysmograph waveform 100 (FIG. 1).
However, the standard plethysmograph can be derived by observing
that the detected intensity signal 300 is merely an out of phase
version of the absorption profile 270. That is, the peak detected
intensity 372 occurs at minimum absorption 272 (FIG. 2), and the
minimum detected intensity 374 occurs at maximum absorption 274
(FIG. 2). Further, a rapid rise in absorption 276 (FIG. 2) during
the inflow phase of the plethysmograph is reflected in a rapid
decline 376 in intensity, and the gradual decline 278 (FIG. 2) in
absorption during the outflow phase of the plethysmograph is
reflected in a gradual increase 378 in detected intensity.
[0039] FIGS. 4 and 5 illustrate exemplary data flows as signals are
processed by an instrument. An artisan will recognize that modern
pulse oximetry instruments may include preprocessing circuitry to
prepare incoming detector signals, one or more signal processors
communicating with the preprocessing circuitry to receive the
preprocessed detector signals and use a wide array of processing
techniques to determine a wide array of measurement values for a
wide array of physiological parameters. The signal processors and
other processing devices can execute sophisticated software to
accomplish processing modules provided herein and known to
processing modules. The signal processors and other processing
devices may include on-chip memory, may be operable communicating
with memory, data storage devices or the like. In addition, one or
more instrument processors may receive the measurement data from
the signal processor(s) and govern the output and display of
information to the user, the output and display being responsive to
the data from the signals processor(s).
[0040] As shown in FIGS. 4, 4A, 5 and 5A, the data flows provide
exemplary methods of processing data collected from an optical
sensor to simulate sounds inside the body (e.g., lung sounds, heart
sounds, stomach sounds, etc.) The methods can be carried out using
a heart sound simulator system including a pulse oximeter in
communication with a processor. The pulse oximeter can include a
sensor configured to obtain data necessary to generate one or more
plethysmographs, and the processor can carry out one or more of the
steps described in connection with methods described herein. Other
embodiments may use the processor of the pulse oximeter to simulate
sounds inside the body.
[0041] Although heart sounds are used as an example throughout the
specification, the methods disclosed herein can be used to convert
the plethysmograph to sounds inside any other portion of the body.
Further, as used herein, the term "plethysmograph" can refer to
either the standard plethysmograph or the intensity
plethysmograph.
[0042] When clinicians check on patients, the clinician may listen
to the patient's heart sounds, which the clinician may or may not
record. Beyond these periodic visits, clinicians do not have access
to heart sounds at any other time intervals. The presently
disclosed methods permit the clinician to listen to the patient's
heart sounds at any time interval based on previously recorded
plethysmographs. Thus, if, for example, the clinician notices or an
instrument flags for the clinician abnormal changes in the
patient's physiological state or trend (e.g. blood pressure, oxygen
saturation, glucose levels, in the morphology of the
plethysmograph, etc.), the clinician can listen to the patient's
heart sounds from time periods around (before, during, and/or
after) the abnormal change. These methods can also be useful for
researchers to access patient data to study trends for a single
patient or a patient population.
[0043] The exemplary methods disclosed herein also decrease the
total amount of storage space necessary to store heart sound
recordings. Audio recordings generally require a large amount of
storage space relative to a plethysmograph. Recording internal body
sounds from multiple parts of the body would require an even
greater amount of storage space. Using the methods described
herein, clinicians may advantageously store a single plethysmograph
over time to convert the plethysmograph into one or more audio
signals representative of different internal body sounds. In an
embodiment, calibration data is also stored with the
plethysmograph.
[0044] The ability to simulate different internal body sounds using
a plethysmograph also decreases the number of cables connected to
the patient. Ordinarily, to record sounds from different sections
of the body, a cable or device would need to be connected to
sensors proximate each of those body sections. The exemplary
methods permit the clinician to obtain the recordings from the data
already being acquired by the pulse oximeter. As the pulse oximeter
is a standard of care instrument in caregiver environments, use of
data already being acquired for new insight and information into a
patient's condition is highly advantageous.
[0045] FIG. 4 illustrates an exemplary data flow 400 of processing
the plethysmograph to simulate heart sounds. Generally, the data
flow 400 can include calibrating plethysmograph samples 402 to
select one or more acceptable plethysmograph waveforms 406 (block
404), and processing the one or more acceptable waveforms 408,
alone or in combination with white noise 414, to create a heart
sound signal 410 (block 408). Finally, the data flow can include
converting the heart sound signal 410 to an audio heart sound
output 418 (block 416), which could be an audio signal, an audible
signal, or data file usable by another device to produce the any or
all of the foregoing. The data flow illustrated in FIG. 4
advantageously reduces the computational processing, and thus
processor usage and processing power consumption used converting
the plethysmograph to an audio output.
[0046] The sample waveforms 402 generated by the pulse oximeter can
include samples of one or more detected plethysmographs. For
example, the pulse oximeter sensor can include a light source
emitting two (2), eight (8), sixteen (16), or other number of
differing wavelengths of light (e.g., 8 LEDs that emit different
wavelengths of light). The light source can be activated so that
just one wavelength of light is active at a given time. One (1),
four (4) or other number of photodiode detectors can detect the
emitted light of each wavelength after attenuation by the body
tissue, such as a finger, toe, ear, nose, hand, foot, forehead, or
the like. In an embodiment, four (4) channels correspond to the
measured data detected by each of the four (4) photodetectors, and
each channel includes the measured data corresponding to each of
the eight (8) wavelengths. Thus, raw data representing thirty two
(32) signal streams (8 .lamda.s.times.4 detectors) can be
generated. Alternatively, the system can use any different number
of LEDs, wavelengths, and detectors. For example, the principles
described herein apply to a system with 12 LEDs emitting 12
different wavelengths that are measured by 6 detectors. Such a
system would generate 72 signal streams of data. Similarly, the
principles described herein apply to a system with 6 LEDs emitting
6 different wavelengths of light that are measured by 3 detectors.
Such a system would generate 18 signal streams of data.
[0047] One or more of the sample waveforms 402 can be selected as
acceptable waveforms 406 for conversion to heart sounds. For
example, the acceptable waveform 406 may be selected based on
waveform characteristics more appropriate for generating audio
output, which may be the same, similar to, or even different from
waveform characteristics more appropriate for visual output to a
patient monitor or continued processing for determining parameter
measurements. For example, waveforms may be selected because of
their morphology, based on pattern matching, through pulse
qualification and detection techniques, or the like. As will be
recognized by an artisan from the disclosure herein, the morphology
of waveforms, the frequency content of waveforms, or the like may
be analyzed to determine the type of waveform characteristics that,
when subsequently processed using the disclosure herein, produce
heart sounds most similar to the original heart sounds or most
beneficial to assist in identifying desired diagnoses or other
information from the sounds produced.
[0048] In some pulse oximeters, pulse oximeters use noise and other
processing to generate or otherwise process the plethysmograph,
resulting in cleaner or otherwise more expected plethysmograph
waveform shape and data. The waveform samples 402 may be responsive
to pre-processed plethysmograph data, semi-processed, or
post-processed plethysmograph data. In alternative or in addition
to audio parameters, the acceptable waveforms 406 may be selected
based on the processing to determine measurement values for
physiological parameters. For example, indications of noise in the
waveforms, or waveforms associated with high confidence processing
techniques may be selected. Also, when parameter processing
determines that conditions of improper sensor application or
misalignment of the sensor's emitter and detector exist, those
corresponding waveforms may be excluded.
[0049] In some examples, one or more of the sample waveforms 402
can be processed before selecting the acceptable waveform 406. Any
of the techniques described herein or generally known in the art
can be used to process the sample waveforms 402. These techniques
can be used alone or in combination with each other. As one
example, the sample waveforms 402 can be interpolated to create the
acceptable waveforms 406. As another example, the sample waveforms
402 can be calibrated by comparing each sample waveform 402 to a
calibration curve specific to the heart sound processor. Since each
of the sample waveforms 402 may be generated at a different
wavelength of light, each of the sample waveforms 402 can be
calibrated using a calibration curve to generate an acceptable
waveform at a wavelength expected by the heart sound processor.
[0050] The terms "calibration curve," "calibration data," and
"calibration information" as used herein include the broad ordinary
meaning in the pulse oximiter industry that an artisan reviewing
this disclosure would recognize, which includes data that maps
measured data to often clinically or otherwise determined desired
data. For example, in the present disclosure, the calibration curve
may include a function, a number of functions, or the like that
capture a relationship between waveform information and heart sound
signals. The heart sound signals may be measured electronically
across a patient population, for an individual patient, or the
like.
[0051] In yet another example, the sample waveforms 402 can be
processed by removing waveforms that do not correspond to
acceptable parameters. These parameters can be based at least in
part on a waveform acceptable for audio output and/or a
physiologically acceptable waveform. Certain waveforms may be
discarded if the shape does not meet certain conditions indicative
of an acceptable waveform. The pre-determined conditions can
include, but are not limited to, the level of curvature, curvature
changes, amplitude, position of peaks and valleys, distance between
peaks and valleys, and/or slope of line intersecting peaks and
valleys. Other processing techniques are disclosed in at least U.S.
Pat. No. 6,463,311, which is hereby incorporated by reference in
its entirety.
[0052] After selecting the one or more acceptable waveforms 406,
the sensor can continue collecting data from the streams of data
corresponding to the acceptable waveforms 406 and store the
corresponding plethysmographs on a storage device, so the clinician
can access the acceptable waveforms 406 when necessary.
Alternatively, if the pulse oximeter continues to collect data from
each data stream, only the acceptable waveforms 406 need to be
stored on the storage device.
[0053] Next, the acceptable waveforms 406, alone or in combination
with white noise 414 generated by, for example, a pseudo-random
noise generator (block 412), can be processed using math modeling
techniques to create a signal simulating heart sounds 410. Any math
modeling technique generally known in the art can be used
including, but not limited to, nonlinear inverse modeling.
[0054] The modeling can be based at least in part on one or more
maps developed for each part of the patient's body. For example,
the one or more maps can illustrate the relationship between heart
sounds and physiological parameters obtained during clinical
trials. The physiological parameters can include information
obtained from a plethysmograph. Alternatively, the map can be
patient-specific. For example, a clinician can record the sounds
from different parts of patient's body using a stethoscope or any
other acoustic device. The recordings and the plethysmograph can be
used create one or more maps illustrating the relationship between
the audio recordings and the patient's plethysmograph from the same
time interval.
[0055] After developing the heart sound signal 410, the heart sound
signal 410 can be input into an audio processor (e.g., codec) 416
to convert the heart sound signal 410 to a heart sound output 418.
If the white noise 414 was not included in the heart sound signal
410, then the white noise 414 can be input at this stage.
[0056] FIG. 4A is another block diagram of an exemplary data flow
through one or more signal processors to simulate a heart sound
using a plethysmograph waveform. The method can include collecting
one or more sample plethysmograph waveforms at a sampling frequency
(block 401). The sampling frequency can be, for example, about 62.5
Hz. Thereafter, a nonlinear inverse model can be used to transform
the sample waveforms to a heart sound signal (block 403). The
sample waveforms can be at least partially transformed by
combination with white noise created by a white noise generator
(block 409). Finally, the heart sound signal can then be processed
using an audio processor (block 405) to create the heart sound
output (block 407).
[0057] FIG. 5 illustrates another exemplary data flow 500
converting a plethysmograph to a heart sound output. Similar to the
method illustrated in FIG. 4, one or more sample plethysmograph
waveforms 502 can be calibrated to select one or more waveforms 506
acceptable for audio output and/or specific physiological
parameters (block 504). The sample waveforms 502 can be calibrated
using any technique described herein or generally known in the art,
including, but not limited to interpolation, comparison with a
calibration curve, and/or removal of waveforms based on
pre-determined parameters.
[0058] The acceptable waveforms 506 can be oversampled at a higher
frequency (block 520). For example, the oversampled waveforms 522
can be generated by oversampling the acceptable waveforms 506 at a
frequency within the audio band for high fidelity sound. In some
embodiments, the oversampling frequency can be at least about 16 Hz
and/or less than or equal to about 16 kHz. The oversampling step
(block 520) can help improve the resolution of the waveform by
generating more data points.
[0059] The acceptable waveforms 506 can be oversampled at any
frequency within the audio band for high fidelity sound, including,
but not limited, any frequency over the sampling frequency that can
help improve resolution. In some embodiments, the acceptable
waveforms 506 can be oversampled at a frequency that is at least
about 50 times and/or less than or equal to about 250 times the
frequency at which the waveform samples 502 are collected. In some
embodiments, the acceptable waveforms 506 can be oversampled 520 at
a frequency that is about 100 times the frequency at which the
waveform samples 502 are collected. For example, the waveform
samples 502 can be collected at a frequency of 62.5 Hz, while the
acceptable waveforms 506 can be oversampled at a frequency of about
6250 Hz.
[0060] The oversampling step (block 520) can include collecting
data from the pulse oximeter sensor at the oversampling frequency,
specifically from the data streams corresponding to the acceptable
waveforms 506. Alternatively, the oversampled waveforms 522 can be
generated using other techniques generally known in the art such as
interpolation. The oversampled waveforms 522 can be stored on a
storage device and recalled when necessary.
[0061] After generating the oversampled waveforms 522, the
oversampled waveforms 522 can be processed using math modeling
techniques generally known in the art (block 508), including, but
not limited to, a linear inverse model or a nonlinear inverse model
to transform the waveforms 522 to heart sound signals 510. In some
examples, both the oversampled waveforms 522 and white noise 514
can be processed together to create the heart sound signal 510. In
other examples, as illustrated in FIG. 5, only the oversampled
waveform 522 is transformed into the heart sound signal 510. In the
latter example, a linear inverse model may be particularly
appropriate because of the simplified inputs.
[0062] As described in connection with FIG. 4, the basis for the
math modeling can be one or more maps illustrating the relationship
between physiological parameters (e.g., plethysmographs) obtained
during clinical trials and heart sounds. Multiple maps
representative of heart sounds from different parts of the
patient's body can be created. For example, a clinician can record
the sounds from different parts of patient's body using a
stethoscope or any other acoustic device and store the patient's
plethysmograph from the same time interval. These sound recordings
and the plethysmograph can be used to create the one or more maps
illustrating the relationship between the plethysmograph and the
different heart sounds. The one or more maps can be developed from
clinical data or specifically derived from each patient.
[0063] The method also includes generating white noise (block 512)
and processing the white noise 514 together with the oversampled
waveforms 522 or heart sound signal 510. In some examples, the
white noise 514 can be passed through a band pass filter to select
one or more tones corresponding to a natural heart sound (block
524). The natural heart tones include tones that clinicians are
trained to expect when examining the patient with a stethoscope. As
shown in FIG. 5, an audio processor processes the heart sound tones
526 together with the heart sound signal 510 to generate a heart
sound output 518 (block 516).
[0064] FIG. 5A is another block diagram of an exemplary data flow
through one or more signal processors to simulate a heart sound
using a plethysmograph waveform. The method can include collecting
one or more sample plethysmograph waveforms at a sampling frequency
(block 501), which, in some examples, can be about 62.5 Hz. The
sample waveforms can then be oversampled at an oversampling
frequency (block 503), which, in some examples, can be about 6250
Hz. After the oversampling step, a linear inverse model can be used
to transform the over-sampled waveforms to a heart sound signal
(block 505).
[0065] A pseudo-random noise generator can create white noise
(block 507), which can be band-pass filtered for specific tones
(block 509), including, but not limited to, specific tones
corresponding to tones clinicians are trained to hear from a
stethoscope. Thereafter, the filtered noise can be combined with
the heart sound signal and processed using an audio processor
(block 511) to create the heart sound output (block 513).
[0066] FIG. 6 illustrates a data flow 600 to convert a
plethysmograph to an EKG output. Ordinarily, an EKG sensor includes
one or more leads attached to different points on the patient's
body. Using the data flow 600 illustrated in FIG. 6, the EKG
simulator can advantageously reduce the total number of sensors and
cables that need to be attached to the patient.
[0067] Similar to the previously described examples, multiple
plethysmograph samples 602 can be calibrated to select one or more
acceptable waveforms 606 according to certain parameters (block
604). These parameters can be based at least in part on appropriate
physiological parameters and/or data necessary for an adequate EKG
output. The sample waveforms 602 can be calibrated using any
technique described herein or generally known in the art,
including, but not limited to interpolation, comparison with a
calibration curve, and/or removal of waveforms based on
pre-determined parameters. These techniques can be used alone or in
combination with each other.
[0068] After selecting the acceptable waveforms 606, the pulse
oximeter can continue to collect data exclusively the data streams
corresponding to the acceptable waveforms 606 and store the
acceptable waveforms 606 on a storage device. If the pulse oximeter
continues to collect data from all of the data streams, then only
the waveforms from the data streams corresponding to the acceptable
waveforms 606 need to be stored.
[0069] Although not illustrated in FIG. 6, in some examples, the
acceptable waveforms 606 can be oversampled to improve resolution
or decrease noise. Any oversampling technique described herein or
generally known in the art can be used. For example, the pulse
oximeter can simply collect data at a higher frequency or
interpolation techniques can be used to oversample the data.
[0070] After selecting the acceptable waveforms 606, the processor
can convert the acceptable waveforms to an EKG output 630 using any
math modeling technique generally known in the art (block 628),
including, but not limited to a nonlinear inverse model or a linear
inverse model. The basis for the modeling can be one or more maps
derived from clinical studies or the patient's own data. For
example, a clinician can store the patient's plethysmograph and EKG
output from the same time interval, and these recordings can be
used to create a map illustrating the relationship between the EKG
output and the plethysmograph. Later generated plethysmographs can
be entered into a model based on these one or more maps to simulate
the patient's EKG output.
[0071] FIG. 6A is another block diagram of an exemplary data flow
through one or more signal processors to transform a plethysmograph
waveform to an EKG output. The method can include collecting one or
more sample plethysmograph waveforms at a sampling frequency (block
601). The sampling frequency can be, for example, about 62.5 Hz.
Thereafter, a linear inverse model (block 603) can be used to
transform the waveform samples into the EKG output (block 605).
[0072] Many other variations than those described herein will be
apparent from this disclosure. For example, depending on the
embodiment, certain acts, events, or functions of any of the
algorithms described herein can be performed in a different
sequence, can be added, merged, or left out altogether (e.g., not
all described acts or events are necessary for the practice of the
algorithms). Moreover, in certain embodiments, acts or events can
be performed concurrently, e.g., through multi-threaded processing,
interrupt processing, or multiple processors or processor cores or
on other parallel architectures, rather than sequentially. In
addition, different tasks or processes can be performed by
different machines and/or computing systems that can function
together.
[0073] The various illustrative logical blocks, modules, and
algorithm steps described in connection with the embodiments
disclosed herein can be implemented as electronic hardware,
computer software, or combinations of both. To clearly illustrate
this interchangeability of hardware and software, various
illustrative components, blocks, modules, and steps have been
described above generally in terms of their functionality. Whether
such functionality is implemented as hardware or software depends
upon the particular application and design constraints imposed on
the overall system. The described functionality can be implemented
in varying ways for each particular application, but such
implementation decisions should not be interpreted as causing a
departure from the scope of the disclosure.
[0074] The various illustrative logical blocks and modules
described in connection with the embodiments disclosed herein can
be implemented or performed by a machine, such as a general purpose
processor, a digital signal processor (DSP), an application
specific integrated circuit (ASIC), a field programmable gate array
(FPGA) or other programmable logic device, discrete gate or
transistor logic, discrete hardware components, or any combination
thereof designed to perform the functions described herein. A
general purpose processor can be a microprocessor, but in the
alternative, the processor can be a controller, microcontroller, or
state machine, combinations of the same, or the like. A processor
can also be implemented as a combination of computing devices,
e.g., a combination of a DSP and a microprocessor, a plurality of
microprocessors, one or more microprocessors in conjunction with a
DSP core, or any other such configuration. Although described
herein primarily with respect to digital technology, a processor
can also include primarily analog components. For example, any of
the signal processing algorithms described herein can be
implemented in analog circuitry. A computing environment can
include any type of computer system, including, but not limited to,
a computer system based on a microprocessor, a mainframe computer,
a digital signal processor, a portable computing device, a personal
organizer, a device controller, and a computational engine within
an appliance, to name a few.
[0075] The steps of a method, process, or algorithm described in
connection with the embodiments disclosed herein can be embodied
directly in hardware, in a software module executed by a processor,
or in a combination of the two. A software module can reside in RAM
memory, flash memory, ROM memory, EPROM memory, EEPROM memory,
registers, hard disk, a removable disk, a CD-ROM, or any other form
of non-transitory computer-readable storage medium, media, or
physical computer storage known in the art. An example storage
medium can be coupled to the processor such that the processor can
read information from, and write information to, the storage
medium. In the alternative, the storage medium can be integral to
the processor. The processor and the storage medium can reside in
an ASIC. The ASIC can reside in a user terminal. In the
alternative, the processor and the storage medium can reside as
discrete components in a user terminal.
[0076] Conditional language used herein, such as, among others,
"can," "might," "may," "e.g.," and the like, unless specifically
stated otherwise, or otherwise understood within the context as
used, is generally intended to convey that certain embodiments
include, while other embodiments do not include, certain features,
elements and/or states. Thus, such conditional language is not
generally intended to imply that features, elements and/or states
are in any way required for one or more embodiments or that one or
more embodiments necessarily include logic for deciding, with or
without author input or prompting, whether these features, elements
and/or states are included or are to be performed in any particular
embodiment. The terms "comprising," "including," "having," and the
like are synonymous and are used inclusively, in an open-ended
fashion, and do not exclude additional elements, features, acts,
operations, and so forth. Also, the term "or" is used in its
inclusive sense (and not in its exclusive sense) so that when used,
for example, to connect a list of elements, the term "or" means
one, some, or all of the elements in the list.
[0077] While the above detailed description has shown, described,
and pointed out novel features as applied to various embodiments,
it will be understood that various omissions, substitutions, and
changes in the form and details of the devices or algorithms
illustrated can be made without departing from the spirit of the
disclosure. As will be recognized, certain embodiments of the
inventions described herein can be embodied within a form that does
not provide all of the features and benefits set forth herein, as
some features can be used or practiced separately from others.
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